Provider Demographics
NPI:1083831465
Name:PALAZZO, LISA NAOMI (LPTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NAOMI
Last Name:PALAZZO
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 SAINT ANDREWS CT
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9073
Mailing Address - Country:US
Mailing Address - Phone:330-533-9827
Mailing Address - Fax:
Practice Address - Street 1:3410 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3210
Practice Address - Country:US
Practice Address - Phone:724-658-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE007319225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant